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Concept: Old age

558

Common mechanisms in aging and obesity are hypothesized to increase susceptibility to neurodegeneration, however, direct evidence in support of this hypothesis is lacking. We therefore performed a cross-sectional analysis of magnetic resonance image-based brain structure on a population-based cohort of healthy adults. Study participants were originally part of the Cambridge Centre for Ageing and Neuroscience (Cam-CAN) and included 527 individuals aged 20-87 years. Cortical reconstruction techniques were used to generate measures of whole-brain cerebral white-matter volume, cortical thickness, and surface area. Results indicated that cerebral white-matter volume in overweight and obese individuals was associated with a greater degree of atrophy, with maximal effects in middle-age corresponding to an estimated increase of brain age of 10 years. There were no similar body mass index-related changes in cortical parameters. This study suggests that at a population level, obesity may increase the risk of neurodegeneration.

Concepts: Old age, Ageing

441

Two decades of research indicate causal associations between social relationships and mortality, but important questions remain as to how social relationships affect health, when effects emerge, and how long they last. Drawing on data from four nationally representative longitudinal samples of the US population, we implemented an innovative life course design to assess the prospective association of both structural and functional dimensions of social relationships (social integration, social support, and social strain) with objectively measured biomarkers of physical health (C-reactive protein, systolic and diastolic blood pressure, waist circumference, and body mass index) within each life stage, including adolescence and young, middle, and late adulthood, and compare such associations across life stages. We found that a higher degree of social integration was associated with lower risk of physiological dysregulation in a dose-response manner in both early and later life. Conversely, lack of social connections was associated with vastly elevated risk in specific life stages. For example, social isolation increased the risk of inflammation by the same magnitude as physical inactivity in adolescence, and the effect of social isolation on hypertension exceeded that of clinical risk factors such as diabetes in old age. Analyses of multiple dimensions of social relationships within multiple samples across the life course produced consistent and robust associations with health. Physiological impacts of structural and functional dimensions of social relationships emerge uniquely in adolescence and midlife and persist into old age.

Concepts: Body mass index, Epidemiology, Vector space, Obesity, Sociology, Hypertension, Old age, Blood pressure

271

Diagnostics of the human ageing process may help predict future healthcare needs or guide preventative measures for tackling diseases of older age. We take a transcriptomics approach to build the first reproducible multi-tissue RNA expression signature by gene-chip profiling tissue from sedentary normal subjects who reached 65 years of age in good health.

Concepts: Medical terms, Genetics, Ageing, Old age, Death, Senescence, Medicine, Health

225

Retirement constitutes a major life transition that poses significant challenges to health, with many retirees experiencing a precipitous decline in health status following retirement. We examine the extent to which membership in social groups following retirement determines quality of life and mortality.

Concepts: Old age, Demography, Ageing, Death, Gerontology, Epidemiology, Longitudinal study, Life

180

Cathie Sudlow and colleagues describe the UK Biobank, a large population-based prospective study, established to allow investigation of the genetic and non-genetic determinants of the diseases of middle and old age.

Concepts: United Kingdom, Europe, Retirement, Ageing, Genetic disorder, Old age, Gerontology, Death

169

The primary purpose of this study was to compare the effects of two different exercise training programs on executive cognitive functions and functional mobility in older adults. A secondary purpose was to explore the potential mediators of training effects on executive function and functional mobility with particular reference to physical fitness gains.

Concepts: Cognition, Old age, Middle age, Exercise

169

OBJECTIVE: To evaluate effects of a multifactorial fall prevention program on fall incidence and physical function in community-dwelling older people. DESIGN: Multi-center randomized controlled clinical trial SETTING: Three medical centers and adjacent community health centers in Taiwan. PARTICIPANTS: Community-dwelling elderly who had fallen in the previous year or with risk of fall INTERVENTIONS: After baseline assessment, eligible subjects were randomly allocated into the intervention group (IG) or control group (CG) stratified by Physiological Profile Assessment (PPA) fall-risk level. IG received a 3-month multifactorial intervention program including 8-week exercise training, health education, home hazards evaluation/ modification, along with medication review and ophthalmology/other specialty consult. CG got health education brochures, referrals and recommendations without direct exercise intervention. MAIN OUTCOME MEASURES: Primary outcome was fall incidence within 1-year. Secondary outcomes were PPA battery (overall fall-risk index, vision, muscular strength, reaction time, balance and proprioception), timed up-and-go (TUG), Taiwanese-International Physical Activity Questionnaire, EuroQoL-5D, Geriatric Depression Scale (GDS), and Fall Efficacy Scale at 3 month after randomization. RESULTS: There were 616 participants with 76±7 years, including low risk 25.6%, moderate risk 25.6% and marked risk 48.7%. The cumulative 1-year fall incidence was 25.2% in IG and 27.6% in CG (HR=0.90, 95% CI 0.66-1.23). IG improved more favorably than CG on overall PPA fall-risk index, reaction time, postural sway with eyes open, TUG, and GDS, especially for those with marked fall-risk. CONCLUSIONS: The multifaceted fall prevention program with exercise intervention improved functional performance at 3-months for community-dwelling elders with risk of fall, but did not reduce falls over 1-year follow-up. Fall incidence might have been decreased simultaneously in both groups by heightened awareness engendered during assessments, education, referrals, and recommendations.

Concepts: Randomized controlled trial, Physical exercise, Old age, Epidemiology, Strength training, Clinical trial, Randomness, Geriatrics

167

BACKGROUND: The ability to drive is important for ensuring quality of life for many older adults. Glaucoma is prevalent in this age group and may affect driving. The purpose of this study is to determine if glaucoma and glaucomatous visual field (VF) loss are associated with driving cessation, limitations, and deference to another driver in older adults. METHODS: Cross-sectional study. Eighty-one glaucoma subjects and 58 glaucoma suspect controls between age 60 and 80 reported if they had ceased driving, limited their driving in various ways, or preferred another to drive. RESULTS: Twenty-three percent of glaucoma subjects and 6.9% of suspects had ceased driving (p = 0.01). Glaucoma subjects also had more driving limitations than suspects (2.0 vs. 1.1, p = 0.007). In multivariable models, driving cessation was more likely for glaucoma subjects as compared to suspects (OR = 4.0; 95% CI = 1.1-14.7; p = 0.03). The odds of driving cessation doubled with each 5 decibel (dB) decrement in the better-eye VF mean deviation (MD) (OR = 2.0; 95% CI = 1.4-2.9; p < 0.001). Glaucoma subjects were also more likely than suspects to report a greater number of driving limitations (OR = 4.7; 95% CI = 1.3-16.8; p = 0.02). The likelihood of reporting more limitations increased with the VF loss severity (OR = 1.6/5 dB decrement in the better-eye VF MD; 95% CI = 1.1-2.4; p = 0.02). Neither glaucoma nor VF MD was associated with other driver preference (p > 0.1 for both). CONCLUSIONS: Glaucoma and glaucomatous VF loss are associated with greater likelihood of driving cessation and greater limitation of driving in the elderly. Further prospective study is merited to assess when and why people with glaucoma change their driving habits, and to determine if their observed self-regulation of driving is adequate to ensure safety.

Concepts: Preference, Absolute deviation, Suspect, Median, Ageing, Gerontology, Middle age, Old age

167

Osteoporosis is a debilitating condition characterized by fractures, pain and premature death. Risk factors for osteoporosis predict the risk of fragility fractures.

Concepts: Middle age, Brain death, Legal death, Clinical death, Ageing, Old age, Gerontology, Death

120

Described in the early 1980s as “The Silent Epidemic,” dementia in the elderly will soon become a clarion call for public health experts worldwide. The epidemic is largely explained by the prevalence of dementia in persons 80 years of age or older. In most countries around the world, especially wealthy ones, this “old old” population will continue to grow, and since it accounts for the largest proportion of dementia cases, the dementia epidemic will grow worldwide. The combined effects of longer lives and the dramatic bulge of baby boomers reaching old age will magnify the epidemic in future decades. Although . . .

Concepts: Ageing, Middle age, Gerontology, Old age